Peripheral venous cannulation

Clinical Procedures > Vascular

Introduction

Wash hands
Introduce self
Patient’s name, DOB and wrist band
Explain procedure and obtain consent
Check for allergies (including chlorhexidine)
Ask preferred (or non-dominant) arm

Preparation

Wash hands
Clean tray
Gather equipment around tray (think through what you need in order)

Equipment list

Gloves x 2
Disposable tourniquet
Alcohol 70%/chlorhexidine 2% skin-cleansing wipe
Cannula (a pink 20G cannula is appropriate for most average sized adult patients)
Sterile gauze
Cannula dressing
Pre-prepared saline flush (or 10ml 0.9% saline + 10ml syringe + blunt fill 18G drawing-up needle) – CHECK DATE
Cannula IV extension set (+ alcohol 70%/chlorhexidine 2% device disinfection wipe)
Tape

Wash hands
Open packets and place neatly in tray, keeping items in plastic parts of packets (without touching the instruments themselves)
If flush is not pre-prepared:
- Wash hands, put on apron and 1^st pair of gloves
- Put needle on 10ml syringe and draw up the 10ml 0.9% saline (holding the saline bottle upside down)
- Remove needle (to sharps bin), expel air and place back into syringe packet
- Place in tray
Priming cannula IV extension set
- Wash hands, put on apron and 1^st pair of gloves (or leave on previous ones if you had to prepare flush)
- Prime cannula IV extension set by flushing 1ml saline flush in to each lumen (ensure no air in any part of lumens)
- Lock all lumens and place cannula IV extension set and flush back into packets
- Place in tray
- Discard waste; then discard gloves and apron; wash hands
Return to patient (with tray and a sharps bin)

Procedure

Vein identification

Wash hands
Expose arm and place a pillow beneath it
Place tourniquet around patient’s arm 4-5 finger widths above intended cannulation site (dorsum of hand/antecubital fossa/forearm)
Identify a suitable vein (i.e. one you can feel, not necessarily one you can see). NB: take sufficient time to find the best vein – this is the main determinant of whether you will be successful or not.
Remove tourniquet

Cannulation

Wash hands
Put on gloves
Sterilise area using skin-cleansing wipe (clean for 30 seconds, then allow to air-dry for 30 seconds)
Re-apply tourniquet
Anchor the skin distally with your non-dominant hand and insert the cannula at 10-30˚ to the skin with your dominant hand
When flashback is observed, advance a further 2mm into the vein (to ensure the cannula tubing is in the vein and not just the needle tip)
Hold the end of the introducer needle steady with your non-dominant hand while fully advancing the cannula tubing into the vein without the introducer needle

Now keep your dominant hand on the cannula (with the needle still partially in) while resting against the patient’s arm to keep it steady. Occlude the vein proximal to the cannula with your dominant hand’s middle finger. While doing this, use your non-dominant hand to:

Remove tourniquet
Place gauze underneath the cannula opening
Remove the needle fully and immediately drop it in the sharps bin
Attach the cannula IV extension set on the end of the cannula
Remove gauze and clean any spilt blood

Securing

Remove the two steristrips from the cannula dressing and stick them on the wings of the cannula
Apply the rest of the dressing
If the dressing has a third sticky strip for filling in the date and time, do this and stick it on top

Flushing

Holding the proximal part of the administration ports of the cannula IV extension set
Clean the ports with the device disinfection wipe
Unlock the lumens
Slowly flush ~5mls 0.9% saline in each lumen (in pulsating manner)
Lock the lumens

To complete

Thank patient and restore clothing
Discard waste and clean tray; then discard gloves and apron; wash hands
Complete a peripheral cannula observation chart (or document with time, date, cannula size, site used and your role in notes)

Try the cannulation OSCE station!

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